Psychologist attitudes towards disclosure and believability of childhood sexual abuse: Can biases affect perception, judgement, and action?

Singh, A., Morrison, B. W., &;Morrison, N. M.

(2023). Child Abuse & Neglect, 146, 106506.

https://doi.org/10.1016/j.chiabu.2023.106506 

Abstract

Background

The perception of CSA disclosure belief is critical to long-term outcomes for CSA survivors. Despite disclosures often occurring in clinical settings CSA survivors do not always report a sense of clinician belief in response to their disclosure. Ascertaining the factors that influence clinician belief is essential to improving outcomes.

Objective

This study examined whether language (i.e., word choice to describe abuse) and ongoing relationship status with a perpetrator impact perceptions of CSA belief amongst psychologists.

Methods

This 2 × 2 within subject's study examined relationship effects (ongoing verses estranged) and language effects (consensual verses abusive), embedded in fictitious vignettes, on believability. Seventy-five participants completed demographic surveys, rated and discussed belief in four vignettes, and completed validated scales capturing clinician trauma history and CSA myth endorsement.

Results

A significant main effect for relationship was found with ongoing victim-perpetrator relationships being less believed than depictions of estranged relationships (F(1,3) = 15.57, p = .001, h2 = 0.174). While no main effect for language was found (F(1,3) = 0.06, p = .801, h2 = 0.001) content analysis of the open-ended items revealed 80 % of psychologists reported being influenced by the language manipulations. Correlations revealed male psychologists were less likely to believe disclosures and more likely to endorse CSA myths than females, and psychologists who had engaged in trauma training appeared to have heightened disclosure belief and lower myth endorsement.

Conclusions

While psychologists generally report belief in CSA disclosures they appear to evaluate specific disclosure aspects to inform this level of belief. Issues around social desirability, measure sensitivity, and learning effects are discussed alongside the importance of trauma training for psychologists.

Here are the important points for mental health professionals:

Enhanced Sensitivity to Biases: Psychologists should be aware of their own biases and how they might affect their perceptions of CSA disclosures. This self-reflection can help mitigate the impact of biases on evaluations and decisions.

Trauma-Informed Training: Providing psychologists with comprehensive trauma-informed training can improve their understanding of CSA, its effects, and appropriate responses to disclosures. This training can foster empathy, reduce skepticism, and enhance the believability of disclosures.

Standardized Assessment Procedures: Implementing standardized assessment protocols for CSA allegations can help ensure consistency and reduce the influence of biases on individual psychologists' judgments.

Support for Survivors: Fostering a supportive and validating environment for CSA survivors is crucial to encourage disclosures and facilitate healing. This involves believing survivors, avoiding judgmental attitudes, and providing appropriate resources and support.

5 Anti-Racist Practices White Scholars Can Adopt Today – #BLM Guest Post

Marius Kothor

TheProfessorIsIn.com

Originally posted 17 June, 2020

We are facing a historic moment of reckoning. The violent murder of George Floyd in Minneapolis ignited a movement that has engulfed the entire country. As people demand companies and organizations to account for their complicity in systemic racism, Black scholars are shedding new light on the anti-Blackness embedded within academic institutions. 

Black scholars such as Dr. Shardé M. Davis and Joy Melody Woods, for example, have started the #BlackintheIvory to bring renewed attention to the Micro and Macro level racism Black scholars experience in academia. A number of white scholars, on the other hand, are using this moment as an opportunity for hollow virtue signaling. Many have taken to social media to publicly declare that they are allies of Black people. It is unclear, however, if these performances of “woke-ness” will translate into efforts to address the systemic racism embedded in their departments and universities. From my experiences as a graduate student, it is unlikely that it will. Yet, for white scholars who are genuinely interested in using this moment to begin the process of unlearning the racist practices common in academia, there are a few practical steps that they can take. 

Below is a list of 5 things I think white scholars can do to begin to address racism in their day-to-day encounters with Black scholars. 

1. Publicly Articulate Solidarity with Black Scholars
2. Stop Calling the Black People in Your Institution by the Wrong Name
3. Do Not Talk to Black People as if You Know their Realities Better than They do
4. Cite Black Scholars in the Body of Your work, Not Just in the Footnotes 
5. Don’t Try to Get Black Scholars to Validate Your Problematic Project 

The full text is here.

These are the Therapist Behaviors that are Helpful or Harmful

Christian Jarrett
Research Digest
Originally published November 23, 2017

Here is an excerpt:

The most helpful therapy moments involved specific treatment techniques, such as times the therapist gave the client a concrete strategy they could use in everyday life; instances when the therapist made connections for the client (such as identifying events that affected their depression symptoms); or helped them process their emotions. Other helpful moments involved fundamental therapist skills, such as listening and expressing empathy, offering support or praise, or when the therapist discussed the process of therapy, including what the client wants from it.

The clients said they found these moments helpful because they learned a new skill, felt heard or understood, gained insight and/or were better able to process their emotions.

In terms of hindering therapist behaviours, these often seemed the same, superficially at least, as the helpful behaviours, including instances when the therapist listened, attempted to express empathy, or attempted to structure the session. The difference seemed to be in the execution or timing of these behaviours. The clients said they found these moments unhelpful when they were off-topic (for instance, their therapist listened to them “rambling” on about irrelevant details without intervening); when they felt like they were being judged; or they felt it was too soon for them to confront a particular issue.

The article is here.

Psychologists with Cancer: Clinical, Ethical, and Practical Challenges

Helen L. Coons, Ph.D., ABPP

Jana N. Martin, Ph.D.

From The Pennsylvania Psychologist

Psychologists living with cancer face clinical, ethical and practical challenges while coping with their own diagnosis and treatments. This brief article offers several suggestions to psychologists in practice and other professional settings who are coping with an early or advanced diagnosis of cancer.

Seek support and supervision. While most individuals are remarkably resilient in coping with cancer and its treatments, a new or recurrent diagnosis and the complex treatment decisions which follow can be highly stressful and frightening. Reaching out to colleagues early for support and supervision is important for psychologists with cancer. Ask colleagues if they know psychologists (or other mental health providers) who have experienced cancer treatment. Practical, informational and emotional support from someone with an insiders’ view is invaluable. The PPA listserv and APA Division listservs may also be helpful in identifying other psychologists with cancer.

Formal supervision from a respected colleague is essential to address clinical, ethical and practical issues that emerge as psychologists cope with cancer, and to support them in developing a practice management plan during and after treatments.

Develop a practice management plan. A cancer diagnosis will typically be followed by  treatment decisions related to surgery, chemotherapy, and/or radiation as well as acute, late, and long-term side effects. At any point in the treatment course, psychologists often face a series of challenging questions related to their practice and other professional roles. Some individuals are too ill, tired, or uncomfortable to work during treatment; some will have to work to maintain their income; and most will likely work part- or full-time with breaks for treatment. Psychologists undergoing cancer treatment are confronted with questions such as: (1) should they continue to see patients, teach, supervise, etc; (2) should they work full- or part-time; (3) if, how and when to disclose their diagnosis to patients, keeping in the mind their practice focus (e.g., children, teens, adults); (4) how to deal with breaks in treatment resulting from additional surgery or side effects of chemotherapy and/or radiation; (5) whether or not to treat patients who have or had cancer, are “at risk” for cancer, have lost a loved one to cancer, have significant attachment issues, or require a high degree of treatment consistency, etc; and (6) clinical, ethical and practical issues when closing a practice. Developing a practice management plan in consultation with a supervisor to address these and other questions can be helpful and empowering (Coons, 2010).

A practice management plan during and after cancer treatment may include creating flexibility in the psychologist’s schedule. For example, some psychologists reduce their patient and teaching load, and/or block their schedule after each chemotherapy cycle when side effects (e.g., nausea, fatigue, pain, low blood counts, etc.) are more likely to emerge and may adversely affect one’s ability to work. Some individuals undergoing chemotherapy have also shifted the focus of their clinical work to more testing or consultation so that they can schedule evaluations between cycles when they have more energy. Others have found that the familiarity of work is a healthy break from cancer treatment. A management plan should include finding colleagues to be on standby to call and re-schedule clients (who have provided informed consent) so that psychologists do not have to explain to patients how they are feeling.

Pace yourself during and after treatment. Throughout and after cancer treatment, psychologists need to be mindful of their physical, emotional and cognitive well-being. Psychologists have an ethical obligation to ensure that their own physical and psychological well-being is healthy enough to care for patients, teach, supervise, etc. Fatigue, pain, nausea and vomiting and the medications used to treat these symptoms or side effects may compromise some individuals’ ability to meet the demands of clinical practice. Chemotherapy and other medications used in cancer treatment, for example, can diminish cognitive functioning. While changes in concentration, memory, processing speed, and the ability to multitask are likely to be mild and time-limited, high level clinical decision-making is essential for differential diagnosis and treatment. Psychologists undergoing cancer treatment must evaluate if they are healthy enough to meet the demands of practice and other professional responsibilities.

Designate a clinical power of attorney. Consistent with the APA Ethical Principles of Psychologists and Code of Conduct (2002), psychologists are obligated to ensure that patients will be taken care of if they are not able to meet professional responsibilities because of personal problems or when there are interruptions in therapy or termination. While many psychologists with cancer will continue to practice during and after treatment, it is important to designate a clinical power of attorney in the event that the psychologist is unable to take care of patients. This colleague should be able to access the psychologist’s office (i.e., they have door and file keys), patient lists, appointment schedules, and records; will contact patients and can either reschedule or provide care to patients, or refer them to other colleagues with the appropriate clinical expertise. See Pope and Vasquez, (2007); Spayd & O’Leary Wiley (2009); and www.apapracticecentral.org for more detailed discussions on closing a practice.

Personal experience with cancer and expertise in psychosocial oncology.  Psychologists who undergo their own cancer treatment will have a special understanding of the experience faced by so many adults across the life span. After treatment, they may even consider taking care of patients with cancer. While well meaning, the psychologist’s own treatment experience is very different from having the expertise in psychosocial oncology necessary to provide evidence-based assessment and treatment to adults with early and advanced cancers. Treating patients with cancer requires a highly specialized fund of knowledge and clinical competencies to ensure quality care and outcomes. While psychologists may want to help others deal with this challenge, they still have the ethical obligation to practice within their scope of expertise. Again, supervision from a respected colleague can be invaluable to sort out if and when a psychologist should treat others with or affected by cancer.

References

American Psychological Association (2002). Ethical principles of psychologists and code of conduct. Washington, DC: Author.

Coons, H. L. (2010). Psychologists with early and advanced breast cancer: Clinical, ethical and practical challenges. Manuscript submitted for publication.

Pope, K. S., & Vasquez, M. J. T. (2007). Ethics in psychotherapy and counseling: A practical guide. San Francisco: John Wiley.

Spayd, C. S., & O’Leary Wiley, M. (2009, December). Closing a professional practice: Clinical and practical considerations. The Pennsylvania Psychologist, 69(11), 15-17.

Helen L. Coons, Ph.D., ABPP, is a board certified clinical health psychologist who is President and Clinical Director of Women’s Mental Health Associates in Philadelphia. She has specialized in psychosocial oncology for 30 years, mentors psychologists and other health care providers with cancer, and underwent treatment for breast cancer. Dr. Coons may be reached at hcoons@verizon.net or 215-732-5590.

Jana N. Martin, Ph.D., is a licensed psychologist in independent practice in Long Beach, CA. Some of her work with children, adults, and families has focused on coping with chronic diseases such as cancer, and she is in remission from lymphoma. She may be reached at drjanamartin@verizon.net.

Upcoming Article: Is Coming Out Always a 'Good Thing'?

*Social Psychological and Personality Science* has scheduled an article for publication in a future issue of the journal: "Is Coming Out Always a 'Good Thing'? Exploring the Relations of Autonomy Support, Outness, and Wellness for Lesbian, Gay, and Bisexual Individuals."

The authors are Nicole Legate, Richard M. Ryan, and Netta Weinstein.

Disclosing a lesbian, gay, and bisexual (LGB) identity to others, or ''coming out,'' has been shown in past research to be associated with mental health benefits (e.g., Ragins, 2004).

Yet, in a world that can be unaccepting of nonheterosexual orientations, coming out also involves risk. LGB individuals may anticipate stigmatization, negative judgments, or rejection feelings that deter them from self-disclosing their sexual identity.

Recent legislation like Don't Ask Don't Tell provides a clear example of this risk: those who came out as LGB in the military were discharged from service. Indeed, some research suggests that coming out can result in other negative consequences such as costs to well-being (D'Augelli, 2006).

It is thus the case that many LGB individuals are selective, varying from context to context in how much they disclose their sexual identity to others.

In the present article, we explore this within-person variability in disclosure using a self-determination theory framework (SDT; Deci & Ryan, 1985, 2000; Ryan & Deci, 2000). SDT (Ryan & Deci, 2000) is a theory of personality and motivation that concerns how social contexts impact motivation and well-being.

According to SDT, social contexts vary in their levels of autonomy support, defined as interpersonal acceptance and support for authentic self-expression (Lynch, La Guardia, & Ryan, 2009; Ryan, La Guardia, Solky-Butzel, Chirkov, & Kim, 2005).

In environments high in autonomy support, people feel accepted for who they are, are free to act and express themselves, and are more open to rely on others. In contrast, in controlling environments, people feel pressured to appear, behave, or perform a certain way (Deci & Ryan, 1985), and they exhibit less openness and more defensiveness (Hodgins et al., 2010).

It is thus likely that autonomy supportive environments reduce perceived risks for coming out, whereas in environments perceived as controlling individuals may be less likely to express a potentially stigmatized part of themselves that could incur censure.

In addition, we argue that the autonomy supportiveness of an environment influences the well-being experienced in that environment as a result of disclosure. Specifically, we expect that LGB individuals who disclose in environments low in autonomy support will not experience the typical boost to wellness from coming out reported in the literature.

Here's how the article ends:

"This research has implications for practitioners providing treatment to LGB individuals because it suggests that people experience greater wellness when they come out in certain contexts, but certainly not all contexts. This research also has implications for workplaces. Providing autonomy support is beneficial for all employees (Baard et al., 2004), but may be especially important for LGB employees' wellness and productivity. Future research should look at disclosing in workplaces that foster self-expression versus controlling work environments and compare wellness and productivity of employees of different sexual orientations. More generally the findings may speak to factors that can facilitate greater openness and wellness in individuals who face stigma, as well as to the costs of controlling social contexts and the self-concealment they often foster."

Thanks to Ken Pope for this information.